To say that a citizen suffers social deprivation is typically thought to imply that the citizen suffers poverty, has poor education, and has a low socioeconomic status. In this blog post, I am not concerned with social deprivation conceived in this way. Rather, what I understand by ‘social’ deprivation is ‘a persisting lack of minimally adequate opportunities for decent human contact’*. According to this definition, citizens suffer social deprivation when they are denied minimally adequate opportunities for interpersonal interaction, associative inclusion, and interdependent care, for example.
Social deprivation is closely related to loneliness – defined as the perceivedlack of opportunities for valuable human contact. A 2010 survey by the Mental Health Foundation reported that, in the UK, only 22% of citizens never feel lonely, 11% feel lonely often, and 42% have felt depressed as a result of loneliness. More tellingly, the survey also found that 48% of citizens strongly agree or agree that people are getting lonelier in general. Strictly speaking, loneliness need not be caused by social deprivation; however, it seems reasonable to think that social deprivation will often play an important causal role.
Worryingly, the adverse affects of social deprivation and loneliness are manifold. For example, various empirical studies have revealed that both social deprivation and loneliness are associated with numerous adverse health outcomes and morbidity and mortality, in particular. Notably, loneliness is reported to be as much as a predictor of bad health as smoking! In addition to their adverse physiological effects, social deprivation and loneliness also have adverse psychological effects: in fact, in extreme cases, such as those involving long-term solitary confinement, social deprivation and loneliness are often reported to be as agonising an experience as torture.
What is the significance of all of this? Clearly, this evidence suggests that, in addition to a concern for citizens’ material interests, we should also have a concern for citizens’ social interests. In other words, we have weighty reasons to care about, and to protect against, social deprivation and loneliness. In the remainder of this post, I outline and briefly defend two more specific proposals that aim at serving this end.
First, our concern for citizens’ social interests seems to suggest that we should prohibit use of institutionalised forms of social deprivation, such as long-term solitary confinement and medical isolation and quarantine. Instead, and even if it is more expensive, we should look to use alternative practices that serve the same function as the original institution, but in a way that protects citizens’ interest in decent human contact. The argument here is simple: evidence suggests that these practices cause considerable psychological and physiological harm, and this harm far outweighs the level of harm citizens – and even serious criminal offenders – are liable to bear.
Second, our concern for citizens’ social interests also suggests that we have weighty reasons to invest in infrastructure that is conducive to the protection of opportunities for decent human contact. This could take the form of mobility assistance for those, such as the elderly, who are most likely to suffer social deprivation, or subsidies for organisations, such as community pubs, that play an important role in meeting many citizens’ social needs. Failing to invest here amounts to risking neglect for citizens’ social interests and, for this reason, must be avoided.
*I take this definition of ‘social deprivation’ from Kimberley Brownlee, ‘A Human Right Against Social Deprivation’, The Philosophical Quarterly, 63 (2013), 199-222.
Thanks for the post Tom, you raise a very important issue that is often overlooked. I am in full agreement with your second proposal and would be interested in a longer list of institutions that must be built and/or improved to further the goal of creating spaces that serve collective social interests. Nonetheless, I do not agree with your first proposal given the specific examples of imprisonment and hospitalisation you presented. In both of these cases there are other public or private interests that seem to me to have a higher priority. Safety and the social interests of the community (which might be impinged upon if the individual is not incarcerated) is higher than than the social interests of the imprisoned person, example 1, and health of patient and/or risk of contamination to the wider community is higher than the social interests of patients, example 2. Thus while I agree that we must begin to consider social interest as fundamental as material interest, it does per se trump other regulatory priorities.
Anya, I agree that there can be higher social interests, but I understood Tom’s comment not as saying that there should be no imprisonment or hospitalization at all, but rather that it can be done in different ways?
More generally, I think that there are really interesting questions here about how exactly states should deal with this issue, because it touches upon deep questions about autonomy, privacy, and well-being. Some of the options are:
a) subsidize infrastructure where it is missing,
b) subsidize individuals, for example those living far apart (e.g. giving them extra money for traveling to other places)
c) design infrastructure in ways that make it more likely that people can experience social life (or built the framework for privately provided infrastructure in such ways) – e.g. with regard to homes for the elderly
d) nudge people? This is likely to be more controversial, but there is at least one way in which most states are nudging (if not coercing) people to be social, insofar as most people have to work to make a living, and most jobs involve at least a basic level of social life.
I think the nudging issue is a really complicated one in this case, because many elderly people say they like to live in their own flats, but are in fact rather lonely, and would have a more sociable life in a (well-run, well-financed!) home for elderly people. But I guess in many cases it’s not so much the state but rather family and friends who have a responsibility to look after them; the state’s responsibility might come in if individuals do not have anyone to look after them any more.
Tom, thank you for raising this really important issue. I want to pick up on Lisa’s final point, which I think is critical: “I guess in many cases it’s not so much the state but rather family and friends who have a responsibility to look after them; the state’s responsibility might come in if individuals do not have anyone to look after them any more.”
I have been thinking a lot about related ideas concerning public service reform and my sense is that we need to move away from two interrelated 'paradigms' – for want of a better word – that have been dominant, but which now seem to be holding our thoughts and proposals within an unhelpful box: the 'compensation paradigm' (so-called by Jo Wolff in his critique of luck egalitarian discourse) and what I'm here going to call the 'state-responsibility' paradigm (which essentially refers to an over-dependence/ reliance upon government intervention).
I think that we can see evidence of this in the idea that citizens are "denied minimally adequate opportunities for interpersonal interaction”, and that "in addition to a concern for citizens' material interests, we should also have a concern for citizens' social interests" which might require us to "invest" in "mobility assistance" and/ or "subsidies for organizations".
Although I don't necessarily disagree with these points, I believe that they are framed incorrectly, and in a way that may actually be counterproductive for the goal of tackling the sources of social deprivation. Also, we must take account of the fact that we are currently experiencing an economic crisis that has called for a deficit reduction plan which is squeezing fiscal resources, and which therefore makes proposals of further compensation claims very difficult to effectively respond to. It seems, then, that “tweaking” the current institutional framework isn’t going to be helpful here, i.e., trying to somehow build citizens' 'social interests' into our existing framework, which seems to have been at least partly responsible for disconnecting us from them in the first place (though I’m not sure that this is a fair assessment of your proposals here; I think perhaps you are trying to do something more?).
An alternative (and potentially more helpful) framing is in terms of the concept of “social productivity”, according to a new “social citizenship” approach to public service reform (which is essentially the idea running through the Conservative’s ‘Big Society’ agenda and Labour’s ‘Good Society’ agenda, but which is most clearly advanced by the 2020 Public Services Hub). This represents an argument in favour of “a new settlement between citizens, communities, and the state which would engage all of us in sharing the responsibility for achieving better social outcomes”. Such reform aims to “foster a new spirit of social citizenship characterized by social responsibility, reciprocity, and resilience”.
This all sounds good, but what would this look like in practice? One example of the effectiveness of this “demand management” concept is ‘Shared Lives’ (see http://www.sharedlivesplus.org.uk/about-us), which seeks to develop small-scale, community, and family-based services for people who might otherwise require formal social services. It is a method of care that can offer marginalised people a greater sense of belonging, whilst creating significant per person/ per annum savings for local authorities.
But it requires a recalibration of the role of the state and of citizens, which would require shifts in culture, power, and finance (away from centralised government); and it might be worth thinking about the scope for (something like) 'nudges' to be used here to change social norms – to ‘prime’ citizens, as it were, for this significant change of relationship with the state and increased collective responsibility.
I guess this is an answer to Tom, Anya and Lisa: Tom, I wholeheartedly agree with the idea that social relationships can be as important to individuals' welfare as material goods, and for their inclusion in the metric of justice. I've been thinking about this myself for over ten years, and one of the things that I find peculiar about social relationships is that, unlike in the case of material goods, one doesn't only want to avoid deprivation; one also needs to avoid (creating, sustaining, nudging people into) *negative* social relationships. One big philosophical question is whether negative social relationships are better or worse than no social relationships (at least one school of psychotherapy, the object-relations theory and its ramifications, think it is better to get negative attention from and interaction with other people than no attention and interaction.) This is very relevant to all kinds of policies: if we are to imprison people, do we want to put them in individual cells, or should we take the risk of abuse and violence that may come with allowing prisoners (in *certain* institutional conditions) to have a social life? Do we want to put responsibility on family and friends, even if this may lead to resentment and – depending on the policy at hand – locking people in relationships they don't like? (See recent developments in China: http://www.nytimes.com/2013/07/03/world/asia/filial-piety-once-a-virtue-in-china-is-now-the-law.html?_r=0)
One more thing: I think social clubs – of which I've seen plenty in Cuba and Buenos Aires – are a great invention! Nudging without any infringement on autonomy – at least on the consumers' end. And how much could they cost, really?
Thanks for the post Tom.
I believe that mental health should be treated with the same level of respect and attention that physical health is within our society. Consequently a society with growing mental health problems has been failed by its government to the same extent as one with increasing physical health issues. I think this is assumed by how you appeal to mental health in your post.
I am not sure though if there is anything special about social inclusion beyond these mental health impacts. Given this and our supreme lack of understanding of mental health, I find it hard to believe that this argument is forceful enough to prompt significant action from the state, with the exception of some obvious marginal cases.
We must invest far more in understanding mental health and why western countries are seemingly increasingly suffering from these problems (or perhaps the decreased stigma is just leading to an increase in reporting?). Then once we understand we can begin to address them, but unfortunately at this point I don't think pubs should be publicly subsidised.
Oh, no, one more thing. This:
is an article about making cities more friendly towards social relationships – in particular, the comparatively very poor city of Bogota. A great success, apparently, and also efficient: benefits trickle into other domains of wellbeing such as physical and mental health and lower car accidents, thus saving money.
My worry with social clubs, is whether these will impact the people we're trying to help? My instincts say the attendees of social clubs are likely to be quite sociable people already who are likely already in possession of meaningful and beneficial human interaction?
Will, might your belief that pubs should not be subsidised have anything to do with the fact that it is easy to also associate them negatively with mental health? What about social clubs – places where neighbours (and tourists) can meet, chat, play music, dance, flirt, cook and eat, play cards (sorry, chess) and, in general, simply hang out together?
Anca – my instinctual reaction to social clubs I've put above.
To flesh it out slightly, I am worried about acting before understanding the causes of social deprivation. My instinctual reaction is that a lack of social institutions is not the driving force for this problem and we need to look deeper at how jobs are being structured, how we are being socialised etc.
The idea of communities as having a major role in individuals social lives seems to be declining. I would point to this as a reason why some social institutions are in decline – Tom's community pubs. Subsidising places such as this are unlikely to have much of an impact if the underlying social structures required for them to be successful are not in place.
Will, I don't know about the impact of communal institutions on boosting the sociability of the previously unsociable (if you have references to research on this I'd be grateful!) But I think that sociability is not enough; without proper infrastructure the most sociable individuals may find themselves isolated, especially I guess in a world with high geographical mobility.
Anca, having been to Bogotà recently, I've been told by a sociology professor I interviewed that the whole city is divided into six zones, according to their socio-economic structure. Although the transmilenio system seems to have done some good, there is still a lot of social segregation going on…
Which raises interesting questions in the current context, because sometimes more homogeneous social structures (say in certain parts of a city) may in fact be more helpful for social networks to develop, because many people feel more comfortable having to do with people who are similar to themselves. Which raises difficult questions about whether there might be some tradeoffs with, say, equality of opportunity.
More generally speaking, I think there are big and puzzling chicken-and-egg-questions about why there is a decline in certain institutions and what are people's preferences. If I remember correctly, Putnam, in "Bowling Alone" (http://bowlingalone.com), mainly found commuting times and television as correlated to a decline in social capital. But the mechanisms for elderly people might be different ones.
Tom you said that you think "community pubs" would be a good way to reduce loneliness. Did you mean pubs in general, or something more specific about how the bigger chain pubs are not as good at bring people together (and hence reducing loneliness)?
I'm quite impressed that you've come up with a way to argue for subsidies for pubs!
The harm argument regarding prisoners seems pretty open and shut really – few would have a problem with that argument if its true that the treatment causes a lot of harm and does little good.
Pubs have been closing down at a rate in the UK no doubt for numerous reasons. Cheap heating and home entertainment no doubt have had an influence (pubs were originally a place that was warmer than home and had no marginal heating costs), and the former at least may be reversed in coming years. Perhaps there has been increased social atomisation in recent years – certainly the Robert Putnam's of this world think so.
Also, are people getting their social interaction instead via the internet, and is this of a different quality to face-to-face interaction.
Your argument would seem to fit well with the capabilities approach, by simply including the capability for social interaction as an important capability. That would also leave it up to people whether they partake or not. (I'm not a fan of the capability approach except for poverty metrics so I'm not necessarily advocating this)
Or would you prefer to link it to a notion of well-being? In that case is it simply part of the broader issue of mental health as Will suggests?
I'd also echo the points above about the place of responsibility in this – how much responsibility for this good is delegated to citizens and taxpayers? Is it a duty of government to consider this issue when making policy (to include it in its box-ticking exercises), or is it stronger than that?
Sorry that's just a bunch of thoughts but maybe something useful in there,
Thanks for the comment, Anya. Lisa is right in that I am not necessarily against imprisonment and medical isolation and quarantine as such; rather I think only that we need to think more about different ways in which these ends could be served without the use of institutionalised social deprivation. For example, perhaps we should look into the practicalities of, and moral permissibility of, using socially assistive technology.
On the point of imprisonment in particular, I think two things are worth noting. First, the long-term effects of solitary confinement can result in the practice setting back rehabilitation and also being very costly to manange. Even if prisoners are liable to bear the costs to serve public interests, it strikes me that the practice, in virtue of its costs, is all things considered impermissible. Second, I think it is important to bear in mind how agonising long-term solitary confinement is. In many respects, it is experienced as a form of torture. If correct, I take it this would rule out it uses even if there were a weight public interest in using it.
Thanks for the thoughtful comment, Fay; in fact, I think that I agree with most of what you say.
I should say, however, that I didn't mean to be committed to what you call 'the state-responsibility paradigm'. (In fact, I was careful not to refer to 'the state' at all in my post.) I was deliberately ambigious about who these duties fall on: whereas some may fall on the state, some may fall on us as private citizens. It certainly seems to me that, given where we are, the best way to serve many of the ends I discuss is for citizens themselves to set up and maintain the kind of projects that you mention.
Its a really interesting point that you make, Anca. To some extent, there answer must be a partly empirical one: it seems partly an empirical matter whether social deprivation is psychologically and physiologically better or worse than negative social relationships. Though I'm not an expert on this, (contra Satre) the evidence from the literature on solitary confinement seems to suggest that negative social relationships are preferable to no social relationships at all.
Thanks, Lisa. The issue of nudging is an important one; it is also raised by Fay in her comment. It seems to me that nudging could play two roles. First, we could nudge citizens not to make poor choices that isolate themselves. Second, we could nudge citizens into providing more social contact with socially deprived citizens. In short, I think I'm more on board with the latter than the former. My worry with the former is that it risks being disrespectful for the goverment to interfere with what are essentially citizens' private choices.
Thanks, Doug. I agree with most of what you say, and the reference to Putnam's work seems to be a helpful one – thanks!
The issue of getting social contact via the internet is important. In a response to Anya's comments I suggested that we should look into the practicalities of, and moral permissibility of, using socially assistive technology, such as the internet. The point is that, though alleviating the problem somewhat, a lack of face-to-face interaction may still be very harmful even if citizens are communicating through the use of technology.
I'm not sure of how best to conceptualise the argument: well being vs capabilities. To some extent, I'm not worried by this: for practical purposes at least, it seems enough to show that we have weighty reasons to protect against social deprivation here and now. Whether these reasons are grounded in capabilities or hypothetical insurance is an important academic matter, but perhaps somewhat tangential to the political point.
Thanks, Bruno. This relates to something Will raised. I think its certainly the case that not all pubs and bars play an important role in protecting against social deprivation. Instead, it seems to me that some types of pubs and bars are much better at playing this role than others. Which types of pubs are the best (and hence most worthy of subsidy) is an empirical matter and would have to be answered when working out the specificities of the policy.
To take a personal example, my local pub has a number of regular customers who have mental health issues and for whom the pub provides their only form of decent human contact. More importantly, from my experience, this is not a one-off case – many local pubs seem to play this crucial role. I'm not sure if this is the case with student bars, but somehow I doubt it.
Thanks Lisa! I can see how advancing community may conflict with realising (fair) equality of opportunity. As I see things, this need not be a big problem, since I am increasingly sceptical about the value of (fair) equality of opportunity in unjust societies.
Hi Tom, can I get a response on whether you believe social deprivation is intrinsically bad or purely instrumentally bad through its impact on mental health?
I feel your post outlines it as instrumentally bad, but I feel you may be on stronger ground removing it from empirical challenge.
Very interesting post, Tom. Although something of my question has already been discussed above, I wonder if I could ask you a couple of points regarding the second move you make towards ensuring certain kinds of opportunities for interaction to support ‘citizen’s social interest’. It seems to me that your case is strongest when you are talking about ways in which we deny people opportunities to interact (e.g., the prison case), or where the ways in which society has addressed certain kinds of issues lead to the same problem (e.g., how we conduct later-life care). But I have a niggling feeling that it is harder to move from these to wider cases of providing/protecting opportunities for human contact. Consider, for example, that your case operates initially (and, I think, most plausibly) from the claim against ‘a persistent lack of minimally adequate opportunities for decent human contact’. I would be surprised if such opportunities do not exist for many people outside the more extreme, specific cases above. Perhaps there could be better opportunities, but a ‘persistent’ lack of ‘minimally adequate’ opportunities? Similarly, I wonder whether there is a problem of finding some way to determine which kind of forums, precisely, would be able to serve this purpose. To take a simple example, note that some of those outside the specific cases who suffer a distinct lack of opportunities for interaction in the UK are people from religious minorities for whom the pub would be ‘off-limits’ for various reasons. I do not mean to suggest that your proposal turns on that case; my point is that we would need to find either a very broad range of forums for interaction, which may be very costly (however one understands costs here), or would not reach some (perhaps even further isolating them). (The same point might apply, I think, to Anca’s suggestion about Bogota; I take it that Lisa’s comment here is not only that the form of community realised there might be problematic for other reasons of social justice, but that it could even problematize certain forms of community.) So, I guess I want to ask you to expand upon exactly what you think would constitute a minimally adequate opportunity for interaction, whether it can apply much beyond certain rather specific cases, and how you could conceive of operationalizing the idea in the latter case in a fair and effective way.
I like your point here, Tom, about the need to think through the impact of solitary confinement on the chances of rehabilitation. Is there any research on this issue that you are thinking about/ referring to in particular?
Tom, this distinction between two potential uses for nudges is really helpful and I think that both are potentially legitimate. Given the huge costs in subjective well-being and the potential associated public costs of people making choices that isolate themselves (i.e., less productive, more prone to mental health issues, etc.), I wonder why you are worried about the first option. It seems to me that pretty much all nudges are attempts by government to interfere with what are essentially citizens' private choices, e.g., with their savings or organ-donation decisions; plus, the justification for nudges is usually made regarding the nudgee's own well-being (as opposed to societal benefit). I think that I agree with you that the second seems more intuitively attractive, but just thought I'd press you a little further on this point as it is of particular interest to me.
Yes, you are correct – I read this assumption into your post. Apologies for that. I think that the main point I wanted to get across was that the framing of the delivery of different interventions could help to further your goal of tackling social deprivation, along the lines that you outline in your response to Lisa above, i.e., in how we can encourage citizens into providing more social contact with socially deprived citizens, which itself would begin to develop a sense of community, community-resilience, a network of support (that is then also set-up for those who initially started out as the citizens who were providing the contact), and empowerment/ a move away from a dependence on governmental intervention. The point being that the 'by-products' of framing and delivery of the policies could themselves either further or detract from your overall goal, and that it is helpful to also think about these "second-order", longer-term effects – which I'm sure you also have in mind.
Well put, Andrew. This is pretty much the underlying idea of what I was trying to get across with regards to responsibility in my earlier post.
Thanks, Will. My sense is that social deprivation is in many cases both intrinsically and instrumentally bad. As it happens, I see the instrumental argument as more powerful – put simply: given just how deleterious the effects of loneliness are, we surely have very weighty reasons to protect against it.
Thanks, Andrew. I think I have two things to say in response. The first is empirical in nature: contrary to what you seem to claim, I think the evidence suggests that many people are in fact denied opportunities for regular and decent social contact. Consider, for example, all those people who lack the mobility to leave the house or who, through stigmatization, find decent social contact very hard to come by. Moreover, in many cases even basic interaction (say, with shop retailers) is not sufficient to ameliorate the most harmful affects of loneliness; instead, something closer to companionship seems to be necessary.
Second, I take your point that the institutional specificities need spelling out in further detail. To some extent, I don't see that as too much of a problem at this stage. My aim is merely to try to put these considerations on the map and the task of working out specifically which institutions we ought to support on these grounds can be left for a later day. My discussion of pubs, for example, is perhaps best thought of as illustrative of my point rather than constitutive of it.